BACKGROUND AND PURPOSE: If early middle cerebral artery signs (EMCAS) are present, prognoses are known to be poor, even if interventional therapy is performed. The aim of this study is to evaluate the clinical effect of a superselective intra-arterial urokinase infusion in cerebral infarction patients presenting EMCAS. METHODS: We conducted prospective longitudinal clinical trial and observed patients (n-22) with middle cerebral artery infarctions who manifested EMCAS in precontrast brain CT scans between January 1996 and April 1997. The patients were divided into two groups, one group (n-11) underwent superselective intra-arterial urokinase infusion; and the other (n-11) was treated with classic osmotherapy and heparinization. We evaluated the clinical outcome for each patient using the Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) on admission (pre-treatment state) and on, the 3rd, 7th, and 30th days. RESULTS: The two patients groups had an even distribution of risk factors, EMCAS, age and the interval from the ictus to the initiation of treatment. The outcome at the 30th day after stroke therapy improved for all patients compared to their status on admission (p<0.01), and there was a significant interaction between the group and the time (p<0.01). This means that the group which underwent superselective intra-arterial urokinase infusion had better clinical outcomes. Hemorrhagic transformation occurred in 5 cases (22.7%), 2 from the superselective intra-arterial urokinase infusion group and 3 from the heparinization group. However, this did not influence the clinical outcome. CONCLUSIONS: Compared to previous reports suggesting the poor prognostic value of EMCAS, even when all patients having these signs, this study showed that the clinical outcomes in the thrombolyic therapy group were better than in the conservatively treated one. Therefore, more aggressive interventional therapies such as superselective intra-arterial urokinase infusion may be considered option.
Brain ; Cerebral Infarction ; Heparin ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; National Institutes of Health (U.S.) ; Prognosis ; Prospective Studies ; Risk Factors ; Stroke ; Thrombolytic Therapy* ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: The success rate of endoscopic endonasal dacryocystorhinostomy (DCR) is not satisfactory enough compared to that of external approach because the newly made ostium is easily obstructed due to granulation tissue formed around the small ostium. The objective of this study is to describe a new technique of an endoscopic DCR which minimizes the stenosis of neo-ostium and to report its success rate. MATERIALS AND METHOD: Twenty patients who had undergone endoscopic DCR with the diagnosis of proximal nasolacrimal duct obstruction were investigated retrospectively. All procedures were done by the same surgeon. The surgical technique includes elevation of mucosal flap, full sac exposure using diamond drill, and design of mucosal flap to cover the denuded bone and approximate with opened sac mucosa. Postoperative symptom improvement and endoscopic finding of the neo-ostium were evaluated. The mean duration of follow-up was 8 months. RESULTS: Ninety percent success rate was noted without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in two patients. CONCLUSION: Endoscopic DCR using mucosal flap after full sac exposure gives satisfactory success rate without any serious complications.
Constriction, Pathologic ; Dacryocystorhinostomy* ; Diagnosis ; Diamond ; Endoscopy ; Follow-Up Studies ; Granulation Tissue ; Humans ; Mucous Membrane ; Nasal Mucosa ; Nasolacrimal Duct ; Retrospective Studies

Lipoblastoma is a rare benign tumor of embryonal fat. This condition most often presents during childhood, before the age of 7 years, affects males more than females, and is typified by a slowly growing, usually subcutaneous mass arising in the limbs. Cases involving the head and neck are extremely rare. Our case arose in a 44-month-old male presenting with a rapidly enlarging soft lump in the right supraclavicular area. Diagnosis is by histology, and treatment of choice is complete surgical resection. We report one case of lipoblastoma in the neck with a review of the literature.
Child ; Child, Preschool ; Diagnosis ; Extremities ; Female ; Head ; Humans ; Lipoblastoma* ; Male ; Neck*

PURPOSE: This study was conducted to investigate whether the use of HA-CMC solution in thyroid surgery influences drainage amount and hospital stay. METHODS: Between November 2012 and December 12, 147 patients with thyroid cancer who underwent total thyroidectomy with central compartment neck dissection were analyzed retrospectively. The patients were divided into four groups; those with or without HA-CMC solution application and high or low output drainage. RESULTS: There were no differences in hospital stay and mean total drainage between the with and without HA-CMC solution application groups (P=0.230, P=0.732). The mean hospital stay was 2.2±0.4 days for the low output of drainage group and 3.1±0.6 days for the high output drainage group (P<0.001). There was no significant difference in the use of HA-CMC solution (41.1% vs. 56.8%, P=0.070). CONCLUSION: The use of HA-CMC solution in thyroid cancer surgery might not increase drainage amount and make hospital stay longer.
Drainage* ; Humans ; Length of Stay ; Neck Dissection ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

To investigate the neuroprotective effects of bovine colostrums (BC), we evaluate the ability of consuming BC after focal brain ischemia/reperfusion injury rat model to reduce serum cytokine levels and infarct volume, and improve neurological outcome. Sprague-Dawley rats were randomly divided into 4 groups; one sham operation and three experimental groups. In the experimental groups, MCA occlusion (2 h) and subsequent reperfusion (O/R) were induced with regional cerebral blood flow monitoring. One hour after MCAO/R and once daily during the experiment, the experimental group received BC while the other groups received 0.9% saline or low fat milk (LFM) orally. Seven days later, serum pro-inflammatory cytokine (IL-1beta, IL-6, and TNF-alpha) and anti-inflammatory cytokine (IL-10) levels were assessed. Also, the infarct volume was assessed by using a computerized image analysis system. Behavioral function was also assessed using a modified neurologic severity score and corner turn test during the experiment. Rats receiving BC after focal brain I/R showed a significant reduction (-26%/-22%) in infarct volume compared to LFM/saline rats, respectively (P < 0.05). Serum IL-1beta, IL-6, and TNF-alpha levels were decreased significantly in rats receiving BC compared to LFM/saline rats (P < 0.05). In behavioral tests, daily BC intake showed consistent and significant improvement of neurological deficits for 7 days after MCAO/R. BC ingestion after focal brain ischemia/reperfusion injury may prevent brain injury by reducing serum pro-inflammatory cytokine levels and brain infarct volume in a rat model.
Animals ; Brain ; Brain Injuries ; Colostrum ; Cytokines ; Eating ; Interleukin-6 ; Milk ; Neuroprotective Agents ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Salicylamides ; Tumor Necrosis Factor-alpha

Internal jugular phlebectasia (IJP) is a fusiform dilatation of the internal jugular vein (IJV), usually presented as a neck mass in children. Accurate diagnosis from carefully directed history, physical examination, and radiological study could result in lifesaving therapy. We performed our study to suggest possible clinical diagnostic criteria for IJP in Korean children. We reviewed three cases of IJP (patients group) and compared the diameter of the internal jugular phlebectasias with diameters of IJVs in ten normal children (control group) using ultrasonography (USG). There were no significant differences in the range of diameters in the resting state between the two groups. The diameters on the right side, compared with those on the left side, showed no statistical significance (p < 0.05). Te range of expanding diameter and average expanding ratios (resting state to Valsalva maneuver X 100%) showed a statistical difference between the two groups (p < 0.05).
Child ; Child, Preschool ; Dilatation, Pathologic/*ultrasonography ; Female ; Human ; Jugular Veins/*ultrasonography ; Korea ; Male ; Valsalva's Maneuver

The funding acknowledgment in this article was omitted as published.

OBJECTIVES: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. METHODS: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation. RESULTS: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. CONCLUSIONS: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
Cause of Death ; Confidence Intervals ; Geographic Information Systems ; Health Services Accessibility ; *Health Status Disparities ; Humans ; Korea/epidemiology ; Life Expectancy ; Mortality/*trends ; Normal Distribution ; Poverty/*statistics & numerical data ; Regression Analysis ; Risk ; Socioeconomic Factors

PURPOSE: The cause of aseptic meningitis remains mostly unknown because viral culture and identification is difficult. Thus, we report a study on 123 children with aseptic meningitis in Gyeongju in 2002 to identify the causing virus and the relationship with the clinical manifestation. METHODS: We prospectively investigated the patients, admitted to Dongguk University Hospital, into two groups between April and October 2002. Group 1 included 123 patients diagnosed as aseptic meningitis. Group 2, the adimssion control, included 120 patients, who suffered from none-enteroviral diseases. Specimens of CSF and stool were collected to perform reverse transcription polymerase chain reaction(RT-PCR), and enteroviral culuture was done in RT-PCR positive patients as well. RESULTS: The male to female sex ratio was 2.2:1 and the mean age was 6.2+/-3.7 years. The clinical manifestations were fever, headache and vomiting. The RT-PCR for enterovirus, performed in 58 cases of CSF in group 1, showed 5.2% positive results and negative result in viral culture. The RT-PCR for enterovirus used in stool specimens showed 89.3% and 41.1% of positive results in group 1 and group 2, respectively. Viral culture of stool specimens showed five cases of echovirus 13 and four cases of echovirus 6 in group 1, whereas three cases of echovirus 6 and one case of coxsackie B4 were detected in group 2. CONCLUSION: The etiologic viruses of the aseptic meningitis outbreak in Gyeongju in 2002 is presumed to be echovirus 13 and echovirus 6. Since echovirus 13 firstly appeared with various age distributions, the outbreak may have emerged due to a lack of acquisition of immunity to this virus.
Age Distribution ; Child ; Echovirus 6, Human ; Enterovirus ; Enterovirus B, Human ; Female ; Fever ; Gyeongsangbuk-do ; Headache ; Humans ; Male ; Meningitis, Aseptic* ; Prospective Studies ; Reverse Transcription ; Sex Ratio ; Vomiting

OBJECTIVES: Identify the characteristics related to the suicide rates in rural and urban areas of Korea and discover the factors that influence the suicide rate of the rural and urban areas. METHODS: Using the data on causes of death from 2006 to 2008, the suicide rates were calculated and compared after age-standardization based on gender, age group and urbanicity. And, in order to understand the factors that influence suicide rate, total 10 local characteristics in four domains - public service, social integration, residential environment, and economic status - were selected for multiple regression analysis. RESULTS: The suicide rates were higher in men than women, in rural areas than urban, and in older people than the younger. Generally, although there were variations according to age group and urbanicity, suicide rates were significantly related to residential environment and regional economic status but not related to regional welfare spending and social integration. In addition, the population over the age of 65 years, only regional economic status has significantly influence on their suicide rates. CONCLUSIONS: The influence of characteristics of regions on suicide rate is various by age-group, gender, and urbanicity. Therefore, in order to lower suicide rate and reduce the gap between regions, various approaches must be adopted by taking into account the socioeconomic characteristics of the regions.
Adolescent ; Adult ; Age Distribution ; Aged ; Cause of Death/trends ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Residence Characteristics ; Rural Population/*statistics & numerical data ; Sex Distribution ; Socioeconomic Factors ; Suicide/*statistics & numerical data ; Urban Population/*statistics & numerical data ; Young Adult